Today three of my patients discharged to hospice. Another died in the hospital. I saw one person with a broken arm and dislocated shoulder. Finally back in my element, I was able to help someone; someone who is going to go home, get outpatient therapy, get better, go back to work. This is what I like about trauma and orthopedics – I have useful skills to offer and my patients get better.
It was only a few days ago that hospital workers were being hailed as heroes. Now we are surplus labor. Due to the uncertainties of the novel coronavirus and questionable planning by senior management, I will soon be out of work. The press release said that senior management would take a temporary 20% pay cut, middle management 10%, and hourly workers would see no cut. A nurse manager informed me that the CEO’s salary is $1.7 million. I am unable to verify this. If that is correct, his reduced salary for 8 weeks will be less than $210,000 – how anyone can be expected to live on that, I don’t know. What didn’t make the press release hit the fan the next day – a 33% cut in hours for hourly employees, with a “choice” of how to take the hit. Two and a half weeks without pay in the next eight weeks. (An update referred to this as “non-requested time off”.) (Like everything else COVID-related in the hospital these days, this could be inaccurate by the time you read it.) If my retirement funds hadn’t taken such a hit this winter, it would be Johnny Paycheck time:
One of my co-workers said she came down with “anal glaucoma – I can’t see my ass working here anymore.” The hall monitors asked the usual: “Self-monitoring? Any new symptoms?” I said, “Yes, I’ve come down with new symptoms – a deep disappointment in, and resentment of, senior management.” She checked the list and said that wasn’t on the list of symptoms, so I could go to work. My daughter in law pointed out that this was actually an acute exacerbation of a pre-existing condition – “he’s been presenting with disappointment in and resentment of upper management for quite some time”.
Another Modest Proposal
President Trump announced his desire to study the effect of injecting or ingesting bleach, rubbing alcohol, or other disinfectants to treat COVID-19.
He may be onto something here; he just didn’t think it through all the way. In related news, hundreds of people crowded onto the state capitol grounds in Madison WI (as they have at other state capitols this week) to protest the governor’s “Safer at Home” order and call for the immediate “re-opening” of the state. This seems like a natural population on which to test my hypothesis.
What if, instead of treating COVID-19, we were able to prevent it? My hypothesis is that 100% of people treated prophylactically with injected bleach will not contract COVID-19.
We would first have to test all of the protesters to ensure that no one is already infected. That would rule them out of the study. We could divide the remaining protesters into an experimental group, to be injected with bleach, and a control group, to be injected with normal saline. We would then measure the rate of infection with COVID-19 after 2 weeks and after a month. I hypothesize that none of the experimental group will be found to have COVID-19 on either of those tests. [Editor’s note: the author further hypothesizes that none of this group will live to the first follow-up, and will die of other causes, but that is not the dependent variable we are studying here.] Granted, this is a convenience sample and not necessarily representative of the general population, but some might argue that is actually the beauty of it.
Growing up, I was taught that the necessities of life were food, clothing, and shelter. Going to work, I found those definitions changing. This is another story alluded to in an old post – “a story for another time”. Here we are, in another time.
So what are the bare necessities in my book, and how did I find them? My first full time job was in a restaurant – preparing food for people. My first “career” was in a grocery co-operative – providing basic food via the Willy Street Co-op. I was pretty sure food counted as a basic need.
After 10 years I left the co-op and moved to Northern California, where I was Maintenance Director (then Financial Manager and General Manager) of the Twin Pines Co-operative Community, a community of 79 families that jointly owned an 80-unit low-income housing co-operative (the 80th unit was a rental reserved for an employee and I was the sole renter for part of my time there). I learned that the Silicon Valley was not filled with Yuppies. Before it became the Silicon Valley, the Santa Clara Valley was The Valley of Heart’s Delight, a vast area of fruit orchards. Now I knew why the supply of apricots had dried up back when I was in the grocery biz – the orchards were being ripped out for factories, office buildings, and housing. (The apricot supply has since recovered somewhat.) There were people who worked in those factories and were the secretaries in those offices and who fixed the fancy cars of those over-priced engineers. They were the people I worked for, and they needed a place to live. Yup, housing made my list.
I’d always had a side job or two. While at Willy Street I was a volunteer programmer at WORT-FM, a listener-sponsored community radio station. I was a patient advocate at the Near East Side Community Health Center, and I was the local representative of FLOC (the Farm Labor Organizing Committee, a farmworkers union started in the tomato fields of Ohio – they later merged with the UFW). In California my side job involved co-operative housing in Nicaragua.
In Nicaragua I found that the Matagalpa River (where we cleaned up after a work day) was also where everyone did their laundry and drew their drinking water, as well as where towns discharged their raw sewage. We found a mountain spring, had the water tested, built a dam and a pipeline, and supplied pure water to the houses we were building. (Fred Colgan deserves the lion’s share of the credit for that.) While we weren’t big enough to set up a sewage treatment program, we dug outhouses so sewage from our little community would not go straight to the river.
When my second visa expired I moved to San Francisco and became a plumber (after a side trip for the Mole Poblano tour, o quiere decir La Vuelta de Mole Poblano). It was pretty clear that clean water and sewage treatment made the list of bare necessities, so I made my living doing that. I mostly did residential service work, but also some remodeling and work in bars and restaurants. I used to tell people that my job involved hanging out in gay bars at 9 o’clock in the morning.
Life being what it is (and a story that I probably won’t bother telling here unless shelter in place lasts a really long time), my plumbing career came to an end. I became a college student and then an occupational therapist. Before I became a patient, I had never heard of occupational therapy. My sister (a Speech and Language Pathologist) defined occupational therapists as the people who come up with a simple commonsense solution to a problem; a solution that seems obvious in retrospect. Then she’d realize that she hadn’t though of it. When people ask me what the difference between a physical and an occupational therapist is, I sometimes say the PT’s job is to make sure you can move around, and my job is to make sure you can do all the things you want to move around for. It is a job that varies widely depending on the setting you are working in; and the lines between what I do and what my PT partner does are sometimes pretty blurry. (If you really want to know the gritty details, I have a 13 hour online course for you. Someday I may be able to do it live again.)
I saw firsthand how much access to healthcare depends on money, and how the US, unlike most industrialized countries, lacks a healthcare system. (I work in a hospital that provides care to all regardless of ability to pay – but that doesn’t mean they don’t get billed later, and it clearly affects the care they get after discharge.) Other countries have a healthcare system. We have an insurance system. Healthcare was now clearly on my list of bare necessities.
A common thread running through these, and made clear by our shelter at home situation, is community. I realized I had found my personal definition of the bare necessities: food, housing, water and sewer, healthcare, and community. I hope my list is complete because I’m closer to 70 than to 60 and I probably don’t want to start another career now. I’d like to pretend I had the forethought 50 years ago to build a life based on the necessities and pretend that my life and career trajectory was planned. Never mind, I don’t even want to pretend that. This was a case of going where life led me, then looking back and seeing what the path looks like. Or, as Robert Hunter said:
Le Tour de France/La Vuelta a España/Il Giro d’Italia
The French tour has been postponed and is now scheduled from 29 August to 20 September. The Spanish tour is still scheduled from 14 August to 6 September, but there is talk of moving it to the fall. The Italian tour is being run in a virtual format and the real version may be moved to late fall. The World Championship is also scheduled in the same timeframe as the rescheduled tours.
I think the only answer to scheduling anything right now is “Who knows?” I know of one cycling event scheduled for June that is still scheduled and another in July that has already been canceled.
Stay safe out there…ride alone and enjoy the scenery.
A couple years ago I mentioned a story for another time. That time is here, so here is another story from the past, this one in Mexico.
I was working for a low-income housing co-op in Santa Clara, CA. On the side I was the Northern California Director of APSNICA (Architects and Planners in Support of Nicaragua). I quit the co-op job so I could move to Nicaragua and work full time, where we were building housing on cooperatively-owned cattle ranches.
I knew my Spanish was too rusty to live and work there, so I stopped off in Mexico for a refresher course at Cuauhnahuac, where I had studied Spanish several years before. I had three weeks to get up to speed. I brought my APSNICA slideshow along. As a self-imposed final exam I would present my 45 minute program in Spanish to the school. I had done it dozens of times in English, but this would let me know if I was ready to live in another country and work in Spanish. (I passed. Since I made up the exam, I got to grade it.)
The school placed students with families so we would be exposed to the language for more than the 6 hours/day we would spend at school. I was placed with a family with several children. The whole family slept on the living room floor to free up the bedrooms for students. One of the kids had had polio when he was younger. At 14 he wore a metal and leather long leg brace, which he took off to play basketball. A hoop (or maybe it was a literal basket, I don’t recall) was nailed to a pole in the street outside their house. Bad leg and all, he beat me more than once. (He called the game “basket”, as in – ¿Quieres jugar basket? -[“Do you want to play basketball?”]- but when he scored, he yelled – ¡Canasta! -[“basket!”])
I had a roommate, who was soon to start medical school -coincidentally in my home town. He said he wanted to be a family practice doctor and wanted to work with low-income clients who were not native English speakers. He knew that med school would present temptations to go into lucrative specialties and he wanted an experience to anchor him so he could resist those temptations. He would spend a few months volunteering in a clinic in a tiny mountain town in Puebla (home of Mole Poblano). A stint at Cuauhnahuac was first on the agenda, so he could talk to his patients.
We became fast friends. I was initially impressed by the maturity of his plan. I quickly remembered what I was doing at that age and how offensive it was when people were impressed by my maturity. I kept my mouth shut.
I went off to Nicaragua and Ken went off to Zacapoaxtla. We agreed to meet and travel together when I finished work. In those days, the only communication available was snail mail. International mail traveled at a snail’s pace. I wrote to Ken with a plan and date that I could arrive. I didn’t hear back.
I took a series of buses to get to Zacapoaxtla. I was the only gringo around. I found a clinic but no one was around. I found a hotel. When I went into the restaurant across the street for dinner, I was asked if I had come to town to see Ken, there being no other reason they could imagine a gringo being there. I said yes and that I had gone to the clinic but couldn’t find him. She told me he didn’t work in this town, but in the next village up the road, Tatoxcac.
After breakfast the next day I started up a narrow road winding through the mountain. I kept passing others walking up the same road, only to have to pass them again later. I learned that there was a path that left the road at every switchback and cut straight through the woods. The walk back down the mountain was much faster.
I made it to the little clinic. It was open but empty. I wandered through and then back outside and saw someone waving to me. The doctor walked up and asked if I were Steve. She said Ken was out of town and would be back the next day. She asked where I was staying and we made a plan for Ken to meet me for breakfast at the restaurant across from my hotel (the one that already knew who I was).
We had breakfast and hatched a plan to conduct a Mole Poblano tour. We traveled by bus from town to town throughout the state of Puebla, eventually getting to Puebla (the capital) itself. We ate Mole in every town. We ate in restaurants big and small, more and less fancy. We concluded that the best Mole Poblano was in a little village where there was a large open courtyard with big picnic tables. Surrounding the courtyard were individual open-air kitchens under a corrugated tin roof held up by poles. Whichever one you sat nearest fed you. The one we chose had two items on the menu – pechuga (breast) and pierna (leg). Either was served in a clay bowl covered in sauce and accompanied by a stack of tortillas. If you ran out of sauce before you ran out of tortillas, they refilled your bowl (no more chicken, just the sauce – but that was the best part). If I dug out my journal I could probably name the town. I could maybe find that market if I found the town. That’s not the point. The point was that we had a really good time eating a lot of really good food and had a great tour of the state in the process. And if we did it again, we might find the best mole somewhere else.
Ken went on to med school, became a family practice doctor, married another family practice doctor, went to work for a community health center (interestingly, the one which took over the clinic where I had volunteered in the 70s), eventually became Medical Director, and is now the CEO. I think his plan worked.
I watched the “One World: Together at Home” concert, with all of the artists recorded at home. I felt like a fraud. Everyone was lauding the heroic frontline healthcare workers risking their very lives. Yes, I’m a frontline healthcare worker. Maybe I’m in the second line. I dress funny nowadays, but mostly I just do my job. I don’t really do anything heroic. Maybe it’s like the old joke about the definition of a Yankee (the closer you get the more specific and nuanced the definition). Or the notion of a “war zone”. In the 1980s, many people in the US considered all of Central America to be a war zone. When you got to Central America, the war zone was in Nicaragua. When you got to Nicaragua, it was the Matalagalpa region. When you got to Matagalpa, it was out near Muy Muy and Matiguás. Where I worked, between Muy Muy and Matiguás, it was over the next ridge. I never saw the war zone.
I’m no hero. But it would be nice if the wall-mounted hand sanitizer dispensers actually had hand sanitizer in them. It would be nice if I hadn’t worn the same single-use mask for three weeks (and counting). It would be nice if I were allowed to wear an N-95 respirator if I saw a COVID-19+ patient – but those are reserved for the ICU and IMC patients. Since I work in an IMC (intermediate care center), I should be careful what I ask for.
This is not a word to be tossed around lightly. But Our Only President first asserted absolute power, then said that the authority rested in individual state governors, then tweeted LIBERATE MICHIGAN, where he doesn’t like the governor and where a shelter in place order is active. I don’t know about you, but I remember a lot of National Liberation Fronts. The point of that word was to overthrow the existing government. So when Trump tweets that we should “liberate” a state (Michigan isn’t the only one, and your state may be next) at a time when a demonstration has been called in that state (and who is organizing and funding those demonstrations?) we all know what he means. Sure, he can hide behind the words and claim he just wants to ensure our constitutional freedoms, but we all know what that word means.
Think about that. We have a president advocating for the overthrow of government – not the federal government, but individual states. He may not be technically committing treason, since he’s not advocating nor attempting to implement the overthrow of the US government; but he is advocating for the overthrow of governments within this country and there is news that funding is coming from people within his government, if not from him personally. We have a president who claimed absolute authority. Then he realized that absolute authority is accompanied by absolute responsibility. Since he has already said, “I don’t take responsibility at all”, he may have figured out that he didn’t really want that authority, as he has spent his career blaming others for his failings. As soon as he relinquished that authority, he began attacking those who took it on.
While writing a letter to Curtis I went back and looked at earlier stuff I’d written to or about him.I came across one of the times I’d avoided an aside by saying, “that’s a story for another time“. It is most definitely another time, so here is one of those stories.
I was visiting in L.A., a place I had tried to live briefly while I pretended to be a college student. I quickly learned that I was cut out for neither L.A. nor college. I will admit to enjoying college 20 years later.
I was staying at David‘s house and I went for a walk in Griffith Park, just down the street from the former campus of Immaculate Heart College, where I had tried to be a student and which was definitely not my alma mater (“nourishing mother” in Latin).
I sat quietly in the woods. I heard a slight rustling and looked up. A deer was staring at me. I said, “We don’t belong here.” The deer seemed to agree and walked away. I left L.A. the next morning, hitchhiking to Yosemite National Park.
I found myself stuck in Fresno; no rides for hours. Fresno’s city motto is “The Agribusiness Capital of the World”, or at least it was then, and it was emblazoned on the side of all city vehicles. I misread it as “The Armpit of the World.” Darkness was falling and I found a cheap motel on the edge of town. The TV news warned of an approaching storm. I hoped to beat it to Yosemite. April in Los Angeles is not the same as April in Yosemite. I had my tent and a warm sleeping bag but I lacked a few other essentials.
I made it to Yosemite Valley the next day under overcast skies. I walked through the valley and out to the edge of the campground. I pitched my tent far from anyone else; not that that was hard, as there were few people even in the valley – a valley that is known for its ethereal beauty and its summertime air pollution.
I found a picnic table and dragged it to a tree. I stood on the table, tossed a rope over the highest branch I could reach, and tied it off. I dragged the table to another tree and did the same with the other end of the rope. I hung my food from the midpoint of the rope and dragged the table far away.
While I had pitched my tent far from any one, I didn’t pitch it far from any thing. I awoke in the middle of the night with an eerie feeling. I raised my hand in front of my face and felt nylon. I crawled out and found that the tent had collapsed. There was a heavy, wet, spring snow falling and the bough above me had sagged enough to drop its load of snow on the tent all at once; a weight the tent couldn’t handle. I cleared away snow and went back to sleep. I had to do the same again later in the night.
I awoke to snuffling sounds near my head. There being no light, I saw no shadows. I just heard snuffling. The snuffler slowly made its way around the tent and left. I awoke in the morning to a winter wonderland. Lacking mittens, I used a pair of wool socks. Looking forward to pancakes with maple syrup, I went over to my food and found the bag on the ground. Claw holes in the plastic bottle of oil had caused all of the oil the bear didn’t drink to leak out into the snow; the same was true of the maple syrup (though, truth be told, I didn’t see much syrup in the snow). I had nothing left except a shredded nylon stuffsack and various plastic containers with clawed holes in them. I looked back up to my rope and concluded it was a very large or very talented bear. I was also hungry.
Yosemite Valley contains a town of sorts. I thought I could find food there so started walking. I came across another camper who called out to me. I told him my story and he shared his bacon bar with me for breakfast. I continued into”town” and did some grocery shopping. I would have food for the weekend and the bear did not drink my stove fuel.
In the middle of the afternoon I was reading in my tent. I heard The Grateful Dead coming through the woods. I opened the tent flap and my breakfast benefactor was trudging through three feet of new wet snow. He had a wineskin filled with a beverage from his home in Sonoma County and some dried herbs from the county to the north, as well as a boombox with Grateful Dead cassettes. The afternoon passed quickly.
Sunday morning I decided it was time to end my winter mountain adventure. I packed up and walked into town and chatted up a few people. I found room in a car headed back to LA and got a ride all the way home.